Differential Delivery of Follow-up Care and Survivorship Among Latinos Using Medicare This application addresses broad Challenge Area (05) Comparative Effectiveness Research and specific Challenge Topic, 05-AA-101 Innovative Analyses of Existing Clinical Datasets. Research shows equal access to cancer treatment and supportive care eliminates disparities in outcomes. Latinos comprise 45.5 million people in the US. Although many reports demonstrate Latinos, compared to non-Hispanics, have lower risks of some diseases and death and even have better health behaviors despite having traditional risk factors associated with poor health such as low income and education levels. Paradoxally, Latinos with some cancers are more likely to die sooner than non-Latinos. For example, a Latina woman diagnosed with breast cancer is 22% more likely to die of breast cancer during the 5 years after diagnosis than a non- Latina white woman of the same age with the same stage of disease. This phenomena needs urgent investigation. The reasons for poorer survival in the Latino community are unclear but may reflect poorer access to timely, high quality treatment. Scientists have not studied if the timeliness of cancer and preventative care that Latinos with breast, prostate and stomach cancers receive impacts their survivorship. This study will focus on the Surveillance, Epidemiology, and End Results (SEER) cancer surveillance data linkage to Medicare. First, this study will assess how soon after a diagnosis Latinos receive standard care for breast, prostate and stomach cancers compared to other ethnic groups. Then this study will determine if delays in either cancer care or general preventative health care depends on where Latinos live (i.e. neighborhoods that are poor, without many doctors or where most residents speak only Spanish). Finally, this study will assess if the delays in treatment and care are associated with earlier death in Latinos compared to other ethnic groups. By the end of the 2-year study period, this study will have trained graduate students in health services research providing infrastructure to address the most challenging questions in health care delivery. Society will know barriers that stand in the way of timely and high-quality care for Latino cancer survivors. This research will assist policy makers, the research community and the health care system apply current knowledge about successful treatments equally throughout the population and ultimately reduce disparities between ethnic and racial groups and develop effective targeted interventions and policies to avoid one-size-fits-all policies that perpetuate disparities in cancer survival. PUBLIC HEALTH RELEVANCE: This project will provide knowledge about the differential delivery of follow-up care and its impact on survivorship in the Latino population. Policy makers, the research community, and health providers will use this knowledge to provide evidence based delivery of care equally throughout the population. This project provides graduate students and disparities researchers'jobs and provides the infrastructure to reduce disparities in ethnic groups adversely impacted by the recession.